title: Heart rate turbulence: standards of measurement, physiological interpretation, and clinical use: International Society for Holter and Noninvasive Electrophysiology Consensus.
abstract: This consensus statement has been compiled on behalf of the International Society for Holter and Noninvasive Electrophysiology. It reviews the topic of heart rate turbulence (HRT) and concentrates on technologies for measurement, physiologic background and interpretation, and clinical use of HRT. It also lists suggestions for future research. The phenomenon of HRT refers to sinus rhythm cycle-length perturbations after isolated premature ventricular complexes. The physiologic pattern of HRT consists of brief heart rate acceleration (quantified by the so-called turbulence onset) followed by more gradual heart rate deceleration (quantified by the so-called turbulence slope) before the rate returns to a pre-ectopic level. Available physiologic investigations confirm that the initial heart rate acceleration is triggered by transient vagal inhibition in response to the missed baroreflex afferent input caused by hemodynamically inefficient ventricular contraction. A sympathetically mediated overshoot of arterial pressure is responsible for the subsequent heart rate deceleration through vagal recruitment. Hence, the HRT pattern is blunted in patients with reduced baroreflex. The HRT pattern is influenced by a number of factors, provocations, treatments, and pathologies reviewed in this consensus. As HRT measurement provides an indirect assessment of baroreflex, it is useful in those clinical situations that benefit from baroreflex evaluation. The HRT evaluation has thus been found appropriate in risk stratification after acute myocardial infarction, risk prediction, and monitoring of disease progression in heart failure, as well as in several other pathologies.
authors.affiliation: Deutsches Herzzentrum, Medizinische Klinik der Technischen Universität München, Munich, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Bauer
authors.forename: Marek
authors.initials: M
authors.lastname: Malik
authors.forename: Georg
authors.initials: G
authors.lastname: Schmidt
authors.forename: Petra
authors.initials: P
authors.lastname: Barthel
authors.forename: Hendrik
authors.initials: H
authors.lastname: Bonnemeier
authors.forename: Iwona
authors.initials: I
authors.lastname: Cygankiewicz
authors.forename: Przemyslaw
authors.initials: P
authors.lastname: Guzik
authors.forename: Federico
authors.initials: F
authors.lastname: Lombardi
authors.forename: Alexander
authors.initials: A
authors.lastname: Müller
authors.forename: Ali
authors.initials: A
authors.lastname: Oto
authors.forename: Raphael
authors.initials: R
authors.lastname: Schneider
authors.forename: Mari
authors.initials: M
authors.lastname: Watanabe
authors.forename: Dan
authors.initials: D
authors.lastname: Wichterle
authors.forename: Wojciech
authors.initials: W
authors.lastname: Zareba
mesh_terms: D001145:Arrhythmias, Cardiac / Q000503:physiopathology*; D017704:Baroreflex / Q000502:physiology; D003245:Consensus Statements as Topic; D006329:Heart Conduction System / Q000503:physiopathology*; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D011379:Prognosis; D018570:Risk Assessment; D014630:Vagus Nerve / Q000502:physiology; D016276:Ventricular Function / Q000502:physiology*